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Infection Prevention and Control CBPG Aerosol-Generating Respiratory Procedures (cont’d) Aerosol-Generating Respiratory Procedures with conclusive evidence of transmission Aerosol-Generating Respiratory Procedures without conclusive evidence of transmission Endotracheal (ETT) intubation Nebulized therapies Cardio-pulmonary resuscitation (CPR) High-Frequency Oscillatory Ventilation (HFOV) Bronchoscopy* Tracheostomy insertion, changing and/or care Sputum induction* Chest physiotherapy Non-invasive positive pressure ventilation for acute respiratory failure (i.e., CPAP, BiPAP) Nasopharyngeal swabs and/or aspirates High flow oxygen therapy Chesttube or chest needle insertion Open artificial airway suctioning (i.e., ETT, tracheostomy) Open suctioning (i.e., mouth or nose) Other breaches to the integrity of a mechanical ventilation system (e.g., filter changes) Mask and either protective eyewear or face shield must be used by staff when within two metres of procedures generating droplets/aerosols * For diagnostic (but not therapeutic) bronchoscopy or sputum induction, must wear an N95 respirator, due to risk from undiagnosed TB (PIDAC, 2012b, p. 16) PPE should be determined by risk assessment All units and crash carts should be equipped with: • a manual resuscitation bag with hydrophobic submicron filter • in-line suction catheters • non-rebreather mask that allows filtration of exhaled gases • PPE (gloves, gowns, masks, eye protection). Page 14 Hand Hygiene Hand hygiene is considered the most important and effective infection prevention and control measure to prevent the spread of health care associated infections (PIDAC, 2012b, p. 9). There are a number of resources available to assist in the proper application of hand hygiene: • Public Health Ontario’s Just Clean Your Hands, which is a hand hygiene improvement program that includes instructional videos for both acute and long-term care practice settings • Provincial Infectious Diseases Advisory Committee (PIDAC) Best Practices for Hand Hygiene in All Health Care Settings, 4th edition (2014), which is best practice guideline on hand hygiene available through Public Health Ontario • Public Health Ontario’s Hand Hygiene for Health Care Settings Fact Sheet • Public Health Ontario’s Your 4 Moments of Hand Hygiene Infection Prevention and Control CBPG www.crto.on.ca Professional Accountabilities: An integral part of an effective hand hygiene program is the promotion of hand hygiene by champions and role models within the health care setting. By being role models for best practices, these champions will take personal responsibility and hold others accountable as part of a facility’s internal responsibility system (PIDAC, 2014, p. 9). Page 15 www.crto.on.ca Infection Prevention and Control CBPG The Four Moments for Hand Hygine 1 BEFOREinitial patient/patient environment contact WHEN? WHY? Clean your hands when entering the patient’s environment: • before touching patient or • before touching any object or furniture To protect the patient/patient environment from harmful germs carried on your hands 2 BEFORE aseptic procedure WHEN? WHY? Clean your hands immediately before any aseptic procedure; for instance: changing a dressing, oral care, drawing blood, administering IV medication To protect the patient against harmful germs, including the patient’s own germs, entering his or her body 3 AFTER body fluid exposure risk WHEN? WHY? Clean your hands immediately after an exposure risk to body fluids (and after glove removal) To protect yourself and the health care environment from harmful patient germs 4 AFTER patient/ patient environment contact WHEN? WHY? Clean your hands when leaving the patient’s environment: • after touching patient or • after touching any object or furniture To protect yourself and the next patient from harmful patient germs Adapted from WHO poster “Your 5 moments for Hand Hygiene,” 2006. Moments for 4 Hand Hygiene Your Catalogue No. 016215 2.5M March 2011 © Queen’s Printer for Ontario 2011 BEFOREINITIAL PATIENT/ PATIENT ENVIRONMENT 1CONTACT AFTER PATIENT/ PATIENT ENVIRONMENT